Influenza surveillance case definitions miss a substantial proportion of older adults hospitalized with laboratory-confirmed influenza: A report from the Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance (SOS) Network.
Infect Control Hosp Epidemiol
; 41(5): 499-504, 2020 05.
Article
in English
| MEDLINE | ID: covidwho-1452452
ABSTRACT
OBJECTIVE:
Older adults often have atypical presentation of illness and are particularly vulnerable to influenza and its sequelae, making the validity of influenza case definitions particularly relevant. We sought to assess the performance of influenza-like illness (ILI) and severe acute respiratory illness (SARI) criteria in hospitalized older adults.DESIGN:
Prospective cohort study.SETTING:
The Serious Outcomes Surveillance Network of the Canadian Immunization Research Network undertakes active surveillance for influenza among hospitalized adults.METHODS:
Data were pooled from 3 influenza seasons 2011/12, 2012/13, and 2013/14. The ILI and SARI criteria were defined clinically, and influenza was laboratory confirmed. Frailty was measured using a validated frailty index.RESULTS:
Of 11,379 adult inpatients (7,254 aged ≥65 years), 4,942 (2,948 aged ≥65 years) had laboratory-confirmed influenza. Their median age was 72 years (interquartile range [IQR], 58-82) and 52.6% were women. The sensitivity of ILI criteria was 51.1% (95% confidence interval [CI], 49.6-52.6) for younger adults versus 44.6% (95% CI, 43.6-45.8) for older adults. SARI criteria were met by 64.1% (95% CI, 62.7-65.6) of younger adults versus 57.1% (95% CI, 55.9-58.2) of older adults with laboratory-confirmed influenza. Patients with influenza who were prefrail or frail were less likely to meet ILI and SARI case definitions.CONCLUSIONS:
A substantial proportion of older adults, particularly those who are frail, are missed by standard ILI and SARI case definitions. Surveillance using these case definitions is biased toward identifying younger cases, and does not capture the true burden of influenza. Because of the substantial fraction of cases missed, surveillance definitions should not be used to guide diagnosis and clinical management of influenza.
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Influenza, Human
Type of study:
Cohort study
/
Diagnostic study
/
Observational study
/
Prognostic study
/
Systematic review/Meta Analysis
Topics:
Long Covid
Limits:
Aged
/
Female
/
Humans
/
Male
Country/Region as subject:
North America
Language:
English
Journal:
Infect Control Hosp Epidemiol
Journal subject:
Communicable Diseases
/
Nursing
/
Epidemiology
/
Hospitals
Year:
2020
Document Type:
Article
Affiliation country:
Ice.2020.22
Similar
MEDLINE
...
LILACS
LIS